{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T04:54:31Z","timestamp":1777092871349,"version":"3.51.4"},"reference-count":27,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,11,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>The purpose of this study was to assess how various realignment strategies affect mechanical failure and clinical outcomes in pelvic incidence (PI)\u2013stratified cohorts following adult spinal deformity (ASD) surgery.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>Median and interquartile range statistics were calculated for demographics and surgical details. Further statistical analysis was used to define subsets within PI generating significantly different rates of mechanical failure. These subsets of PI were further analyzed as subcohorts for the outcomes and effects of realignment within each subcohort. Multivariate logistic regression analysis controlling for baseline frailty and lumbar lordosis (LL; L1\u2013S1) analyzed the association of age-adjusted realignment and Global Alignment and Proportion (GAP) strategies with the incidence of mechanical failure and clinical improvement within PI-stratified groups.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>A parabolic relationship between PI and mechanical failure was noted, whereas patients with either &lt; 51\u00b0 (n = 174, 39.1% of cohort) or &gt; 63\u00b0 (n = 114, 25.6% of cohort) of PI generated higher rates of mechanical failure (18.0% and 20.0%, respectively) and lower rates of good outcome (80.3% and 77.6%, respectively) than those with moderate PI (51\u00b0\u201363\u00b0). Patients with lower PI more often met good outcome criteria when undercorrected in age-adjusted PI-LL mismatch and sagittal age-adjusted score, and those not meeting good outcome criteria were more likely to deteriorate in GAP relative LL from first to final follow-up (OR 13.4, 95% CI 1.3\u2013139.2). In those with moderate PI, patients were more likely to meet good outcome when aligned on the GAP lordosis distribution index (LDI; OR 1.7, 95% CI 0.9\u20133.3). Patients with higher PI meeting good outcome were more likely to be overcorrected in sagittal vertical axis (OR 2.4, 95% CI 1.1\u20135.2) at first follow-up and less likely to be undercorrected in T1 pelvic angle (OR 0.4, 95% CI 0.2\u20130.9) by final follow-up. When assessing GAP alignment, patients were more likely to meet good outcome when aligned on GAP LDI (OR 3.5, 95% CI 1.4\u20138.9).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>There was a parabolic relationship between PI and both mechanical failure and clinical improvement following deformity correction in this study. Understanding the associations between this fixed parameter and poor outcomes can aid the surgeon in strategical planning when seeking to realign ASD.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2024.5.spine24106","type":"journal-article","created":{"date-parts":[[2024,9,7]],"date-time":"2024-09-07T01:54:37Z","timestamp":1725674077000},"page":"572-578","source":"Crossref","is-referenced-by-count":1,"title":["Should pelvic incidence influence realignment strategy? A detailed analysis in adult spinal deformity"],"prefix":"10.3171","volume":"41","author":[{"given":"Tyler K.","family":"Williamson","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina;"},{"name":"Department of Orthopaedics, University of Texas Health San Antonio, Texas;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oluwatobi O.","family":"Onafowokan","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew J.","family":"Schoenfeld","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Brigham and Women\u2019s Hospital, Harvard Medical Center, Boston, Massachusetts;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephane","family":"Owusu-Sarpong","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, NYU Langone Medical Center, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jordan","family":"Lebovic","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, NYU Langone Medical Center, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jamshaid","family":"Mir","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ankita","family":"Das","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nathan","family":"Lorentz","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, NYU Langone Medical Center, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew","family":"Galetta","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, NYU Langone Medical Center, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pawel P.","family":"Jankowski","sequence":"additional","affiliation":[{"name":"Hoag Neurosciences Institute, Irvine, California; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Renaud","family":"Lafage","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Lenox Hill Hospital, Northwell Health, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Virginie","family":"Lafage","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Lenox Hill Hospital, Northwell Health, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter G.","family":"Passias","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"2","key":"b1","series-title":"Neurosurg Clin N Am","first-page":"143","article-title":"Clinical and radiographic evaluation of the adult spinal deformity patient","volume":"24","author":"Smith JS","year":"2013","unstructured":"Smith JS, Shaffrey CI, Fu KM,  Clinical and radiographic evaluation of the adult spinal deformity patient. 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